E-18 Clinical Case Slide - Knee I Friday, June 2, 2017, 9: 30 AM - 11: 30 AM Room: 402
HISTORY: A 29-year-old male professional dancer presented with 6 weeks of right anterior knee pain after landing a jump in knee extension. His pain worsened with jumping & squatting and improved with rest. He denied systemic symptoms, other joint pain or medication use. He was evaluated by the company’s physical therapist & treated for patellar tendinopathy, including eccentric strengthening, cho-pat strap & jump restrictions, without improvement.
PHYSICAL EXAMINATION:Exam showed bilateral knee crepitus, right proximal patellar tendon tenderness and pain with right leg squat & hop. His exam was otherwise normal.
Patellar tendon tear
TESTS AND RESULTS:
Knee US: Focal hypoechogenicity & fiber disruption in the right medial proximal patellar tendon
Right knee MRI: Increased signal on T2 & STIR confirming partial tear of the proximal patellar tendon
Right proximal patellar tendon tear
TREATMENT AND OUTCOMES:
Initial treatment included knee immobilization, activity restriction, topical nitroglycerin & PT for 3 months without improvement. The patient pursued an US-guided platelet-rich plasma (PRP) injection without tenotomy at an outside facility. He had partial improvement but dance remained restricted. Subsequent US at 6 months showed persistent tear. US-guided tenotomy and PRP injection were repeated, followed by activity restriction, PT and return to activity protocol. He noted limited relief at 4 weeks and pursued a third PRP injection at an outside facility. He developed worsening, diffuse anterior knee pain. US showed new thickening and heterogeneity throughout the right patellar tendon.
MRI confirmed hypertrophic changes. Given prolonged course, he underwent open patellar tendon debridement & repair. Intra-operatively, the tendon was noted to be significantly thickened with abnormal color & texture. Post-operative follow-up is ongoing.